This blog maintains the thoughts on various topics related to biomedical and health informatics by Dr. William Hersh, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University.

Wednesday, June 3, 2015

Informatics is Important When Information Is Important

Many of us in the informatics field, myself included, sometimes believe that the value proposition of informatics is so intuitively obvious that we do not need to explain it to the rest of the world. API-based interoperability? Secondary use of clinical data? Standardized terminology? Their value is so certain that we need not explain it. Not!

However, informatics is in the mainstream of healthcare now, and healthcare recognizes that using data and information to improve processes and outcomes while reducing costs is an essential part of doing business. Clearly there is room for improvement in how operational informatics is being done, but there is no turning back. This means that the priorities for our field are now driven largely by forces external to it. This is not necessarily a bad thing, as we must adapt to play our role optimally for the greater benefit to healthcare.

The main driver for the importance of data and information is changing care delivery models. Some of this can be attributed to the Affordable Care Act (aka, Obamacare), but in reality, healthcare has been changing for some time. The centerpiece of this change is a move away from "volume-based" to "value-based" payment. This is certainly true in the Medicare system, where a goal for the next few years has been established such that the majority of reimbursement will have some modification by quality or value, with half of all payments made through alternative payment models, such as accountable care organizations [1].

By contrast, in the older, volume-based "fee-for-service" model of reimbursement, information is not as important. The physician or the hospital provide their care and are reimbursed for it. Information is mostly important to the extent that all charges are captured.

But in the new value-based payment world, information becomes more important. Whether the physician or hospital is paid under a capitated model or as a bundle for specific diagnoses and/or procedures, there is some element of financial risk on the part of the provider. Especially when combined with a requirement for quality measures, the physician or hospital has incentive to provide the best care at the lowest cost. Information becomes much more important when there is motivation for quality, efficiency, and reduction of complications. The route to that information is through the proper application of informatics.

In this new value-based world, information becomes more important as it allow better management of costs and quality. In an article last year, Bates et al. laid the most important areas for managing high-risk and high-cost patients from the growing volume of data [2]:

High-cost patients – looking for ways to intervene early

Readmissions – prevention

Triage – selecting appropriate level of care, including transfer vs. staying in community

This provides a nice list of the priorities for capture and use of information as a driver to increase quality while reducing the cost of care. Informatics is now mainstream, and must become part of the larger healthcare team. It does not mean that our larger visions no longer matter, but rather that we must work with the rest of the system for the betterment of patients.